Efficacy and safety of ramucirumab in gastric or gastroesophageal cancer: A systematic review and meta-analysis

Background

Ramucirumab is considered a potential treatment for gastric or gastroesophageal cancer; however, its safety has not been evaluated. This meta-analysis aimed to evaluate the efficacy and safety of ramucirumab for treating gastric or gastroesophageal cancer.

Methods

The databases of PubMed, Embase, and Cochrane Library were searched through October 2023. The search focused on randomized controlled trials (RCTs) comparing ramucirumab (with or without chemotherapy) to a placebo (with or without chemotherapy) in patients with gastric or gastroesophageal cancer. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were pooled.

Results

Seven RCTs with a total of 2613 patients were included. Compared with placebo (with or without chemotherapy), ramucirumab (with or without chemotherapy) significantly improved OS (HR: 0.90, 95% CI: 0.82–0.99, p = 0.030), PFS (HR: 0.74, 95% CI: 0.60–0.90, p = 0.003), ORR (OR: 1.39, 95% CI: 1.15–1.67, p < 0.001), and DCR (OR: 1.91, 95% CI: 1.38–2.63, p < 0.001). However, ramucirumab (with or without chemotherapy) also increased the incidence of decreased appetite (OR: 1.29, 95% CI: 1.09–1.53, p = 0.004), diarrhea (OR: 1.39, 95% CI: 1.01–1.91, p = 0.05), hypertension (OR: 3.13, 95% CI: 2.03–4.83, p < 0.00001), and bleeding or hemorrhage (OR: 2.34, 95% CI: 1.93–2.85, p < 0.00001).

Conclusions

Ramucirumab (with or without chemotherapy) can improve OS, PFS, ORR and DCR in patients with gastric or gastroesophageal cancer. However, it may also increase the incidence of specific AEs.